The December 17 MLN Connects Call provides an overview of the 2014 Physician Fee Schedule (PFS) Final Rule. This presentation covers program updates to the Physician Quality Reporting System (PQRS). In particular, this call includes details on how an eligible professional (EP) or group practice can meet the criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment. In lieu of satisfactory reporting, the call also covers how to meet the criteria for satisfactory participation under the new qualified clinical data registry option, which will be implemented in 2014 as a result of the American Taxpayer Relief Act of 2012. In addition to the PQRS, this presentation contains additional program updates to the Electronic Health Record (EHR) Incentive Program and Physician Compare. A question and answer session follows the presentation.

Agenda:

Program updates for PQRS

How an EP or Group Practice can meet the criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment

Criteria for satisfactory participation under the new qualified clinical data registry option

On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case ofJimmo v. Sebelius, involving skilled care for the IRF, SNF, HH, and OPT benefits. “Nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving Medicare coverage.”

The goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled. The settlement agreement sets forth a series of specific steps for CMS to undertake, including issuing clarifications to existing program guidance and new educational material on this subject.

As part of the educational campaign, this MLN Connects™ Call will provide an overview of the clarifications to the Medicare program manuals. These clarifications reflect Medicare’s longstanding policy that when skilled services are required in order to provide reasonable and necessary care to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration. In this context, coverage of skilled nursing and skilled therapy services “…does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Portions of the revised manual provisions also include additional material on the role of appropriate documentation in facilitating accurate coverage determinations for claims involving skilled care.

Agenda:

Clarification of Medicare’s longstanding policy on coverage for skilled services

No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims that require skilled care

On January 15, CMS, Center for Clinical Standards and Quality (CCSQ) will host an MLN Connects™ Call on the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP). The ESRD QIP is a pay-for-performance quality program that ties a facility's performance to a payment reduction over the course of a payment year (PY). This MLN Connects Call will focus on thefinal rule for operationalizing the ESRD QIP in PY 2016, which was put on display on November 22, 2013.

The performance period for PY 2016 will begin on January 1, 2014. Facilities and other stakeholders should take steps to understand the contours of the program. After the presentation, participants will have an opportunity to ask questions.

Agenda:

ESRD QIP legislative framework and how it fits in with CMS strategies to improve quality

Changes reflected in the final rule based on public comments

The final measures, standards, scoring methodology, and payment reduction scale that are applied to the PY 2016 program

Special Open Door Forum: Final Rule CMS-1599-F: Hospital Inpatient Admissions

Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions

Thursday, December 19; 1-2pm ET

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CMS will host a third, follow-up call in its Special Open Door Forum (ODF) series to allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule (CMS-1599-F) and corresponding medical review instruction. For recently released provider information, including updates to the frequently asked questions and a recently identified “rare & unusual circumstance,” please visit theInpatient Hospital Reviews web page. Note: The “rare & unusual circumstance” appears in Section III.D.2 of the Download, “Reviewing Hospital Claims for Patient Status 11/27/2013.”

Feedback and questions on the two midnight provision for admission and medical review can be sent toIPPSAdmissions@cms.hhs.gov.Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule.

Save the date for upcoming CMS provider trainings. CMS will host a series of provider trainings for the Hospice Item Set (HIS) in February and May 2014. Beginning July 1, 2014, hospices will be required to submit 2 HIS records for each patient admission – a HIS-Admission record and a HIS-Discharge record.

Trainings will be divided into two sessions:

HIS data collection training: will be held over two half-day sessions on February 4and 5, 2014 in the afternoon.

This training will be geared towards teaching hospice providers how to complete the HIS-Admission and HIS-Discharge. The training will cover each item in the HIS, including instruction on how to complete each item, examples for each item, and a question and answer session.

The training will be video-streamed live online on February 4and 5. The training will also be videotaped and will be posted on the CMS Hospice Quality Reporting Program (HQRP) website at a later date for provider viewing and download. Limited on-site attendance at this training will also be available.

HIS Technical training: will be held in May 2014, exact date TBD.

This technical training for hospice providers and vendors will cover topics such as registration, obtaining user IDs, submitting files to the Quality Improvement and Evaluation System Assessment Submission and Processing (QIES ASAP) system, and reviewing final validation reports.

Details about the date, time, and delivery method of this training are not yet available. Providers should check the CMSHQRP website for updates.

Providers cannot yet register for either the HIS data collection or the HIS technical training sessions. Further details about HIS training registration processes will be posted on the CMSHQRP website as they become available. Providers should visit the CMS HQRP website on a regular basis for the most up-to-date information.

Further details about the HIS training will also be discussed on December 11, 2013 during a HIS Special Breakout Session on the Home Health, Hospice, and DME Open Door Forum (ODF). The agenda for the December 11 ODF, including dial-in information, is available for download on the ODF website.

Announcements

National Influenza Vaccination Week — December 8-14

December 8-14, is National Influenza Vaccination Week (NIVW). NIVW is a national health observance established to highlight the importance of continuing influenza vaccination. Historically, seasonal flu vaccination activity drops significantly at the end of November. While patients are engaged in holiday mode, it is important to remind them to get vaccinated to protect themselves and their families against the flu. Continue flu vaccination through the holiday season and beyond. It’s not too late to vaccinate. Seasonal flu vaccination is also important for health care providers and their staff.

Generally, Medicare Part B covers one seasonal influenza virus vaccination per influenza season for all beneficiaries. Medicare may cover more than one seasonal influenza virus vaccination per influenza season if a physician determines, and documents in the beneficiary’s medical record, that the additional vaccination is reasonable and medically necessary. A Medicare beneficiary pays nothing (no coinsurance or copayment and no Medicare Part B deductible) for the flu vaccination, if he or she gets the vaccine from a Medicare-enrolled provider. Financial responsibilities may apply for the beneficiary for the administration of the vaccine if the provider does not accept assignment.

For more information on coverage and billing of the influenza vaccine and its administration, please visit:

While some providers may offer flu vaccines, those that don’t can help their patients locate flu vaccines within their local community. TheHealthMap Vaccine Finder is a free, online service where users can search for locations offering flu and other adult vaccines.

On November 29, CMS issued a notice (CMS-6051-N) announcing a $542.00 CY 2014 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2014 and on or before December 31, 2014.

Deadline for Physician-owned Hospitals to Report Ownership and Investment Information Extended to March 1

The deadline for physician-owned hospitals to report ownership and investment information pursuant to Section 6001 of the Affordable Care Act has been extended to March 1, 2014. Physician-owned hospitals that submitted the information on or after December 1, 2012, consistent with the process specified inMLN Matters® Article #SE1332, will be considered to have met the new March 1, 2014 deadline. Additional information is available on thePhysician-Owned Hospitals web page.

CMS Announces Quality Strategy

CMS has released the CMS Quality Strategy. Driving quality improvement is a core function of CMS. This commitment is particularly evident as CMS enhances its partnerships with a delivery system in which providers are supported in achieving better outcomes in health and healthcare at lower cost for the beneficiaries and communities they serve. The vision for the CMS Quality Strategy is to optimize health outcomes by leading clinical quality improvement and health system transformation.

The CMS Quality Strategy is built on the foundation of theCMS Strategy and the HHS National Quality Strategy (NQS). Like the NQS, the CMS Quality Strategy was developed through a participatory, transparent, and collaborative process that included the input of a wide array of stakeholders. For more than a year, a group of leaders from across CMS met and developed the strategy. This group also sought out advice and input from other HHS agencies, the community, and CMS beneficiaries to inform their efforts.

The CMS Quality Strategy pursues and aligns with the three broad aims of the NQS and its six priorities. Each of these priorities has become a goal in the CMS Quality Strategy. Four foundational principles guide the Agency’s action toward each of these goals. This document identifies quality-focused objectives that CMS can drive or enable to further these goals. Quality interventions are inherently interrelated, thus many goals include concepts that could be articulated under more than one goal. As we organized and structured objectives, we sought to put them in the place that captures where the primary driver of change occurs.

A new release of the Short-Term (ST) Acute Care Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through the third quarter of FY 2013, is available for short-term acute care hospitals (STACHs) nationwide. The PEPPER provides hospital-specific data statistics for Medicare discharges in areas that may be at risk for improper Medicare payments. Hospitals can use the PEPPER to support internal auditing and monitoring activities. The PEPPER is a free report comparing a hospital’s Medicare billing practices with other hospitals in the state, Medicare Administrative Contractor (MAC) jurisdiction and nation. Access theST PEPPER User’s Guide for more information. CMS has contracted with TMF® Health Quality Institute to develop and distribute the reports.

The PEPPER was distributed electronically to STACHs through a My QualityNet secure file exchange to hospital QualityNet Administrators and user accounts with the PEPPER recipient role in late November.Note: Effective with this release the “PTCA with Stent” target area has been restored and is renamed “Percutaneous Cardiovascular Procedures.” CMS encourages hospitals to provide feedback on the PEPPER through afeedback form so that the reports can be continually improved.

Reporting Period for EPs in the EHR Incentive Programs Ends December 31

December 31, 2013, is an important deadline for eligible professionals (EPs) participating in the EHR Incentive Programs. It marks the end of the calendar year and the last day of the 2013 meaningful use program year.

Attestation DeadlineIf you are an EP participating in the Medicare EHR Incentive Program, you have until February 28, 2014, to attest to demonstrating meaningful use of the data collected during the reporting period for the 2013 calendar year. You must attest by 11:59 p.m. Eastern Standard Time on February 28 to demonstrate meaningful use. If you are participating in the Medicaid EHR Incentive Program, please refer to yourstate’s deadlines for attestation information. You must attest to demonstrating meaningful useevery year to receive an incentive and avoid a payment adjustment.

Payment Adjustments Payment adjustments will be applied beginning January 1, 2015, if you have not successfully demonstrated meaningful use. The adjustment is determined by the reporting period in a prior year. For more information, visit thepayment adjustment tipsheet. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, youmust demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

EPs in 2014January 1, 2014 marks many important milestones for EPs participating in the EHR Incentive Programs, including:

The start ofStage 2 for EPs who have already completed at least two years of Stage 1.

The last year that Medicare EPs can begin participation and earn an incentive.

A 3-month reporting period in 2014, regardless of the stage of meaningful use, to allow time to upgrade to 2014 certified EHR technology.

Medicare EPs beyond their first year of meaningful use must select a three-month reporting period fixed to the quarter of the calendar year.

Medicare EPs in their first year of meaningful use may select any 90-day reporting period that falls within the 2014 calendar year.

Medicaid EPs can select any 90-day reporting period that falls within the 2014 calendar year.

The FY 2014 Inpatient Prospective Payment System (PPS) PC Pricer is now available on theInpatient PPS PC Pricer web page in the “Downloads” section.

FY 2013 Inpatient PPS PC Pricer Updated

The FY 2013 Inpatient Prospective Payment System (PPS) PC Pricer has been updated with the October provider data. The latest version is now available on theInpatient PPS PC Pricer web page in the “Downloads” section.

MLN Matters® Special Edition Article #SE1338, “Improve Your Patients’ Health with the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)” was released and is now available in a downloadable format. This article is designed to provide education on Medicare coverage of an annual preventive visit for all Medicare patients. It includes information on the differences between the IPPE and AWV.

The “Medical Privacy of Protected Health Information” Fact Sheet (ICN 006942) was released and is now available in downloadable format. This fact sheet is designed to provide education on resources and information regarding the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and how this rule applies to customary health care practices. It includes guidance on common patient encounters with the Privacy Rule and lists HHS HIPAA web page resources.

“Vaccine Payments Under Medicare Part D” Fact Sheet — Released

The “Vaccine Payments Under Medicare Part D” Fact Sheet was released and is now available in a downloadable format. This fact sheet is designed to provide education on Vaccine Payments under Medicare Part D. It includes information on the difference between Part B and Part D vaccine coverage, what Part D covers, and additional information on vaccine coverage under Part D plans.

The “Inpatient Psychiatric Facility Prospective Payment System” Fact Sheet (ICN 006839) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). It includes the following information: background, coverage requirements, how payment rates are set, FY 2014 update to the IPF PPS, and quality reporting.

“The DMEPOS Competitive Bidding Program: Traveling Beneficiary” Fact Sheet (ICN 904484) was revised and is now available in downloadable format. This fact sheet is designed to provide education to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers that provide items to Medicare beneficiaries who reside in or travel to competitive bidding areas. It includes information on how to determine whether a beneficiary is in a traveling status, how to properly bill Medicare for the item, and how Medicare will determine the payment amount.

“The DMEPOS Competitive Bidding Program: Referral Agents” Fact Sheet (ICN 900927) was revised to include information about the Round 1 Recompete and is now available in downloadable format. This fact sheet is designed to provide education about the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program for health care providers who order or refer items of DMEPOS.

“The DMEPOS Competitive Bidding Program: Enteral Nutrition” Fact Sheet (ICN 901005) was revised and is now available in downloadable format. This fact sheet is designed to provide education on requirements for providing enteral nutrition therapy under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program. It includes rules for enteral nutrition payment.

“Communicating With Your Medicare Patients” Fact Sheet — Revised

The “Communicating With Your Medicare Patients” Fact Sheet (ICN 908063) was revised and is now available in downloadable format. This fact sheet is designed to provide education on communicating with your Medicare patients. It includes background information and communication tips that will help you understand and respond to all patients; older patients; and racially, ethnically, and culturally diverse patients.

“DMEPOS Quality Standards” Booklet — Reminder

The “DMEPOS Quality Standards” Booklet (ICN 905709) is available in a downloadable format. This booklet is designed to provide education on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). It includes DMEPOS quality standards as well as information on Medicare deemed Accreditation Organizations (AOs) for DMEPOS suppliers.

“Medicare Coverage of Imaging Services” Fact Sheet — Reminder

The “Medicare Coverage of Imaging Services” Fact Sheet (ICN 907164) is available in downloadable format. This fact sheet is designed to provide basic information about Medicare coverage, billing, and payment of all imaging services. It includes specific information concerning billing, coding requirements, and an overview of coverage guidelines for radiology and non-radiology diagnostic imaging and image-guided procedures. It is also the featuredProduct of the Month for December.

New MLN Educational Web Guides Fast Fact

A new fast fact is now available on theMLN Educational Web Guides web page. This web page provides information on Evaluation and Management services; Guided Pathways that contain resources and topics of interest; lists of health care management products; and easy-to-understand billing and coding educational products. It is designed to provide educational and informational resources related to certain CMS initiatives. Please bookmark this page and check back often as a new fast fact is added each month.

Submit Your Feedback on the MLN Learning Management System and Product Ordering System

Your feedback is important to us as we use your suggestions to improve your experience using the Medicare Learning Network® (MLN) Learning Management System and Product Ordering System to take web-based training courses and order MLN educational products. We encourage you to submit your feedback online. Your participation is strictly anonymous and greatly appreciated.

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